Pneumonia

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Pneumonia

  1. 1. PneumoniaSteven Podnos MD
  2. 2. Etiology• Aspiration primary cause for bacterial pneumonia• Aerosol transmission important for viral/atypical/TB• Abnormal host response may be important in immuncompromised patients- neutropenia, PCP• Important to know oral flora
  3. 3. Risk Factors• Community Acquired “Healthy”• Community Acquired “Sick”• Health Care Associated
  4. 4. Clinical Features• History• PE- RR,Fever, Hypoxemia, Hypercapnia, Shock, Che st Pain• Sputum• CXR• WBC, Na• ABG
  5. 5. Community Acquired Pneumonia• Etiology-Viral/Atypical/Bacteria- Pneumococcus, H. Flu• Clinical Presentation guides both decision to admit and initial Rx• Discuss Diagnostic Approach
  6. 6. Criteria for clinical stability. Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72© 2007 by the Infectious Diseases Society of America
  7. 7. Clinical indications for more extensive diagnostic testing. Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72© 2007 by the Infectious Diseases Society of America
  8. 8. Therapy• Timing of first dose important• Length of Rx variable• Oral vs. IV considerations
  9. 9. Recommended empirical antibiotics for community-acquired pneumonia. Mandell L A et al. Clin Infect Dis. 2007;44:S27-S72© 2007 by the Infectious Diseases Society of America
  10. 10. Health Care Associated Pneumonia• Increased risk of aspiration if intubated• Ventilator Care Bundles• Other attempts to prevent• Etiology, MDR, Gram neg, Staph and MRSA but can also have CAP type organisms
  11. 11. Potential Pathogens Combination Antibiotic Therapy*Pathogens listed in Table 3 and Antipseudomonal cephalosporin MDR pathogens (cefepime, ceftazidime) Pseudomonas aeruginosa or Klebsiella pneumoniae (ESBL+) Antipseudomonal carbepenem Acinetobacter species (imipenem or meropenem) or ß-Lactam/ß-lactamase inhibitor (piperacillin–tazobactam) plus Antipseudomonal fluoroquinolone (ciprofloxacin or levofloxacin) or Aminoglycoside (amikacin, gentamicin, or tobramycin) plus Methicillin-resistant Staphylococcus aureus (MRSA) Linezolid or vancomycinLegionella pneumophila
  12. 12. Non Antibiotic Rx• Oxygen• ARDS net ventilation vs BiPAP• IVF• Resp RX
  13. 13. Non responders

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